Humana

About Humana

 

Job Category:

Member Quality & Financials - Medical Coding

Country:

United States

Postal Code:

40201

Approximate Salary:

Not Specified

Position Type:

Full Time

Nurse Auditor 2 - Louisville, KY

Humana - Louisville, Kentucky

Posted: 12/12/2018

Description

The Nurse Auditor 2 performs clinical audit/validation processes to ensure that medical record documentation and diagnosis coding for services rendered is complete, compliant and accurate to support optimal reimbursement. The Nurse Auditor 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Responsibilities

The Nurse Auditor 2 validates and interprets medical documentation to ensure capture of all relevant coding. Identifies members with high risk CMS Hierarchical Condition Categories (HCC) and refers cases for annual follow-up care by disease management, case management, and primary care providers as appropriate for assessment/intervention. Identifies the root cause analysis of audit findings and submits recommendations for appropriate change management. Applies clinical and coding experience to conduct reviews of provider codes and billing. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.

               

Required Qualifications
•    Bachelor's Degree
•    Active Registered Nurse (RN) license 
•    3+ years acute outpatient hospital coding experience or outpatient auditing experience
•    Demonstrated ability to lead process/project initiatives
•    MS Office proficiency
•    Demonstrated ability to exercise solid judgment and discretion in handling and disseminating information 
•    Ability to work independently and manage work load
•    Customer-service focused and exhibit professionalism, flexibility, dependability, desire to learn, commitment to excellence and commitment to profession
•    Excellent writing, editing, interpersonal, planning, teamwork, and communications skills
Preferred Qualifications
•    RHIA, RHIT or CCS credentials
•    Nurse Coder Background 
•    Prospective payment methodologies, auditing experience
•    Clinical documentation improvement knowledge
•    CPT procedural code experience
Additional Information
Interview Format 

As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Montage Voice to enhance our hiring and decision-making ability. Montage Voice allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. 
If you are selected for a first round interview, you will receive an email correspondence (please be sure to check your spam or junk folders often to ensure communication isn’t missed) inviting you to participate in a Montage Voice interview. In this interview, you will listen to a set of interview questions over your phone and you will provide recorded responses to each question. You should anticipate this interview to take about 15 to 30 minutes. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews. 

Scheduled Weekly Hours

40

Apply Now